Project Summary (Techniques Development) The National Pediatric Rehabilitation Resource Center (PedRehab Ctr) will engage in development of techniques we consider highly promising, responsive to critical gaps in methods or technology in the field, and potentially multi-purpose in their application. Specifically, the areas we propose to pursue have application for both research and clinical practice. Pediatric rehabilitation research would benefit immensely from more sensitive, valid, and reliable approaches to measuring the emergence of new skills and their use in everyday function. Many tools in the new Common Data Elements (CDEs) for Cerebral Palsy were developed initially for typically developing children; others apply to only limited age ranges but often are used ?off label;? and some designated as ?exploratory? or ?highly promising? lack confirmation (and likely further refinement) of their psychometric properties. Another major problem in pediatric rehabilitation trials has been the failure to measure Fidelity of Treatment (i.e., adherence to intended treatment protocols). Our PedRehab Ctr scientists have been active in developing and validating novel assessment tools from sophisticated kinematics to parent report tools; creating first ever Fidelity of Treatment tools for pediatric Constraint-Induced Movement Therapy and Bimanual treatment; and exploring the incorporation of various neuroimaging approaches to document treatment-induced neuroplasticity. Our specific aims for Techniques Development are: 1. To obtain confirmatory documentation of assessment methods for function, skill, and behaviors that go across laboratory and real-world environments. This includes use of kinematics and video-, game-, robotic-, and wearable-devices to supplement traditional standardized tests and systematic methods for establishing clinically meaningful thresholds for gain and losses; 2. To standardize modifications and summary scoring methods of currently used tools to allow for greater specificity and for use with children who vary widely in age, severity, and etiologies of neuromotor impairments; 3. To advance the development of Fidelity of Treatment measures to provide much-needed documentation of the actual delivery of rehabilitation interventions; and 4. To explore novel neuroimaging strategies for use as individual biomarkers and as valid, reliable indicators of treatment-induced neuroplasticity.